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£s€>~*/i^k~4& *^€Y*€*^^ +2?(£ * SU' 



OBSERVATIONS 



ON 



THE EPIDEMIC 



NOW- 



PREVAILING IN THE CITY OF NEW- YORK; 



CALLED THE 



ASIATIC OR SPASMODIC CHOLERA; 



WITH 



ADVICE TO THE PLANTERS OF THE SOUTH, 

FOR THE 

MEDICAL TREATMENT OP THEIR SLAVES, 



BY CHRISTOPHER C. YATES, M.D, 



NE W.YORK: 

PRINTED BY GEORGE P. SCOTT AND CO 

CORNER OF NASSAU AND ANN STREETS 

1832. 



v \S» 



\ 



•*~/4 -&£> 



OBSERVATIONS 



ON 



THE EPIDEMIC 



NOW 



PREVAILING IN THE CITY OF NEW-YORK; 



CALLED THE 



ASIATIC OR SPASMODIC CHOLERA; 



WITH 



ADVICE TO THE PLANTERS OF THE SOUTH, 



MEDICAL TREATMENT OF THEIR SLAVES. 



Q 



BY CHRISTOPHER C. YATES, M.D. 



NE W-YORK: 



PRINTED BY GEORGE P. SCOTT AND CO, 

CORNER OB NASSAU AND ANN STREETS. 



1832. 




./nY 3 






Uj-68 



Entered according to the Act of Congress, in the year 1832, by G. P. Scott, in the Clerk's 
Office of the District Court of the Southern District of New- York. 



Mt% 



INTRODUCTION. 



The following pages do not strictly comprehend a treatise 
on the spasmodic cholera. They merely contain observations 
elicited from time to time by what has been done during its 
prevalence in this country. They are intended to point out 
the errors which, in the writer's opinion, have occurred in the 
management and treatment of the disease ; and, if possible, to 
lead to a correction of those errors. 

In order to render this pamphlet more useful and instructive 
to the reader, it may not be out of place here to point out the 
premonitory and fixed symptoms of the malady ; a good descrip- 
tion of which, in accordance with the writer's own judgment 
and observation, is contained in the following extract from a 
report of a committee appointed by the medical society of this 
city, signed by John Stearns, M. D. chairman. 

" The best writers on cholera asphyxia, generally agree that 
it is invariably preceded by the following symptoms : 

" The patient complains of lassitude and a partial uneasiness 
in the region of the stomach, accompanied with some slight 
evacuations from the bowels, insufficient however to excite his 
attention or alarm. As these symptoms increase, and the eva- 
cuations become more frequent, from two to twelve times 
a day, accompanied with increased griping, his countenance 



IV INTRODUCTION. 

becomes sharp and dark, of which he seems to be perfectly 
unconscious. Occasional nausea sometimes appears at this pe- 
riod. These symptoms generally continue, varying in severity, 
from one to ten days before the second stage supervenes. The 
evacuations at first are of a dark brown or blackish hue. As 
the looseness continues, they become of a less natural appear- 
ance, until they assume the consistence and aspect of dirty 
water. Some headache, cramp of the fingers, toes and abdo- 
men, slight giddiness, and singing in the ears, accompany these 
symptoms. Sometimes a costiveness of two or three days' 
duration supervenes, which is immediately succeeded by a re- 
turn of the diarrhoea, and in a few hours after by a collapse of 
the whole system, with nausea and vomiting." 

Of the remedies recommended by the various authors and 
writers on the subject from abroad and at a home, I dare not 
undertake the record. They would fill as many pages as this 
pamphlet contains. The recipes are as numerous as the Ara- 
bian tales. 

These are, opium in all its modifications, camphor, oil of 
peppermint, brandy, capsicum, cajeput oil, table salt, pepper, 
mustard, ice, calomel, jalap, charcoal, burnt oats, lard, mint and 
cinnamon waters, maple sugar, cataplasms, injections, poultices, 
dry and moist heat, frictions, sulphur, hot and tepid baths, to- 
bacco juice, cordials, cupping, leeching, bleeding, saline injec- 
tions into the veins, electricity, lye, turpentine, soot, hartshorn, 
ether, and a thousand et cceteras ; all and every of which have 
had and have their successful advocates ! And add to them, as 
if in mockery of the desires of nature, the total prohibition of 
drinks, particularly cold water, under the most ardent and un- 
quenchable thirst ! 

" Can such things be, 

And overcome us like a summer cloud, 

Without our special wonder 1" 



INTRODUCTION. V 

If the disease, as is contended, be of a special character, why 
has there not, in the seventeen years of its prevalence, yet been 
discovered and adopted a special remedy ? Its mortality is 
evidently as great and terrific now as it was several years ago, 
when it commenced its ravages in Europe. Daring this period 
it has been the subject theme of scientific research, and has 
called into action the most noted medical talents ; but, that we 
are not, as yet, advanced a single jot in our remedial knowledge, 
I appeal to historical and existing facts. 

The power of " disinfecting agents," except on stench and 
putridity, I deem extremely problematical. We want proof 
that the atmosphere is less pure now than at other seasons. 
We want proof — only probable proof — that the air contains a 
particle of specific infecting matter, or that the morbid cause 
does not exist in our own constitutions, and has been accumu- 
lating for months or seasons. Twenty years ago I thought, 
with the late Dr. Alexander Coventry, that all epidemics had 
their predisposing causes operating on the constitution for 
months previous to their breaking out, as the seed in the ground, 
in due time to spring into life. 

But allowing that imperceptible particles of infectious matter 
exist in the atmosphere, what proof have we that the chlorides 
will alter their nature or their properties ? Only from this ana- 
logical deduction, that inasmuch as chloride destroys the stench 
of putridity, it must of consequence destroy the substance mat- 
ter of infection — an unphilosophical deduction at best. But let 
us come to a case in point. Will chloride destroy the poison- 
ous quality of arsenic, the emetic property of antimony, or the 
soporific effect of opium ? If not, what right have we to sup- 
pose it will otherwise affect an imaginary particle of poisonous 
matter floating in the atmosphere ? We cannot know, from 
any thing that has yet been discovered, that chlorides have the 



VI INTRODUCTION. 

slightest chemical influence on the quality of any matter except 
its odor, much less on that of the matter in question. Hence I 
conclude that all the expense incurred for their distribution 
throughout our streets and yards is a mere boon to public alarm 
and prejudice. The only proof we have of the benefits of 
chlorides is in their very useful effect of combining with offen- 
sive effluvia, so as to render them insensible to the organs of 
smell and taste. 

I am not unaware of the opposition I shall encounter in the 
following publication. I am sensible that I tread hard upon 
professional corns, and that I am avowing opinions and doc- 
trines in discordance with a great majority of physicians. 

My system of evacuants in this disease has been condemned 
by a number of my brethren.* They say I must be " mad " — 
well, be it so. I was honored with the same appellation in the 
winter of 1812-13, during the prevalence of an epidemic as 
mortal as this, and much of the same character. Then, too, 
laudanum and brandy were the order of the day, and they 
proved as efficacious then, in our several cantonments and mili- 
tary hospitals, and through the northern and western parts of 
this state, as do the same remedies in our present epidemic. 
Many will remember the great mortality, particularly at the 
military stations, where for the first five weeks, on an average, 
three out of five died of the " winter fever," as it was termed. 
I then published an essay on the disease, founding my views 



* I avail myself of a note, whilst the above is in press, to state, that about 
three weeks ago, Dr. Thompson of Sunderland, in England, was in this city, 
and communicated the following facts to a gentleman of my acquaintance. 
Dr. T. left Sunderland after the cholera had ceased its ravages. He stated, 
that he had seen it and attended it in all its various forms — that no case proved 
fatal where emetics or cathartics, or both, were resorted to, in the early stages 
of the disease ; and that the physicians eventually discarded the stimulating 
treatment, both externally and internally, as utterly useless and unavailing. 



INTRODUCTION. Vll 

on the same principles that I have here adopted. In that case, 
however, my " madness " became as epidemic as the disease 
itself, and my course of treatment was instantly adopted by 
both army and private physicians, and the scene was to me a 
very flattering change. The disease became completely ma- 
nageable. 

Again, in 1822, when I first removed to this city, the yellow 
fever became prevalent. I treated my patients with emetics. 
But here again I was heterodox. Authority denounced 
emetics, as not only improper, but dangerous, in this formida- 
ble disease, and I was again called "mad." What was the 
result ? I was successful in nineteen cases out of twenty. 
Others lost nearly half of their patients. My treatment was 
the result of practice and experience ; theirs of theory and of 
professional authority. My success was too palpable to escape 
the observation of physicians ; and I had the gratification of its 
acknowledgment from the candid and liberal, and was compli- 
mented with the fact of the adoption of my mode of treatment 
by others. 

Now, in 1832, I am again " mad " ! Well, I hope and trust 
that my present aberration of mind may not prove a less dis- 
appointment among my professional brethren than my former 
attacks. This fact I aver, and can prove, that no case has 
proved fatal under my treatment. 

Were I to relate the many anecdotes, both tragical and co- 
mical that have come under my observation during this disease, 
of subjects treated, and reported to the board of health, as 
cases of "Asiatic cholera," they would excite the smiles of 
pity, ridicule, and contempt. But this introduction is already 
too long. 

I have read several treatises and letters, both from Europe 
and of this country, on the cholera, They do not, I fear, lead 



Vlll INTRODUCTION. 

to safe results. I will here cheerfully except a letter from Dr. 
^Caldwell of Montreal, which comprehends more useful and 
practical instruction, and is a better guide for the treatment of 
this disease than is contained in all the pamphlets that have been 
written on the subject ; and the very able and philosophical 
communications of Dr. Bronson of Albany, in a series of letters 
to the mayor of that city, which do him much credit, and evince 
a thinking and independent mind. To me, personally, both these 
gentlemen are utter strangers ; hence I am not actuated by 
motives of partiality in the expression of my opinions. 

In the course of my remarks it will be perceived that I have 
avoided as much as possible to enter on speculative notions or 
theoretical subtleties. I have endeavored to confine myself to 
simple facts, on which only have I founded my deductions. 

These facts, and their deductions, have been verified by a 
number of cases of indubitable character, and several of a most 
malignant nature. The latter particularly demanded, and re- 
ceived, the most active remedial treatment that I have thought 
necessary to adopt, namely, vomiting and purging by antimony 
and calomel; and I can assure the reader, with confidence and 
truth, that the result has been invariably successful. As the 
disease, in all its forms, has but one general character, it is rea- 
sonable to suppose, that but one general course of treatment is 
necessary for its cure. That course is laid down in the follow- 
ing pages ; and if its adoption should meet with as much success 
in the hands of others as it has in mine, the philanthropic mind 

can well appreciate the value of my reward. 

C. C. Y. 

New-York, August 13th, 1832. 



OBSERVATIONS ON CHOLERA 



The following article was written on the 18th of June, be- 
fore the cholera had made its appearance here : 

To the Editors of the Courier and Enquirer* 

Gentlemen : I perceive that you have partaken of the 
general alarm and consternation occasioned by the recent 
reports of the cholera morbus from Canada. Come, gentle- 
men, let us coolly, dispassionately, and deliberately examine 
the reports, the disease, and the remedy of and for this fearful 
cholera. 

First, the reports : You will have learnt before this article 
is in print, that reports cannot be relied on, in cases where 
wonder or admiration are concerned. 

Secondly* the disease : What is it ? A malignant cholera 
morbus : and only differs from the same disease known as such 
by all medical writers, in its being epidemical. Its mortality, 
in proportion to the number attacked, is no greater than it has 
ever been in this or in any other country. The number of 
cases and the liability to the attack, alter not the nature or the 
character of the disease itself. When this disease becomes 
epidemic or endemic, and at certain periods, like all other dis- 
eases, proves more mortal than at others, still it is not the 
more or less the malignant cholera ; as scarlet fever is still 

2 



guisli this disease in its mild and its aggravated or malignant 
state, and the strong analogy the latter state bears to the 
* effects of poison from arsenic. 

I shall have need to remark upon the treatment proposed 
and recommended by the " Edinburgh Board of Health." I 
shall take the definition from their celebrated and learned 
Dr. Cullen, who confessedly in his description of diseases 
may be considered the best authority. He describes its 
symptoms truly ; and that is all I ask for my present pur- 
pose. 

" In this disease, a vomiting and purging concurring toge- 
ther, or frequently alternating with one another, are the chief 
symptoms. The matter ejected both upwards and downwards 
appears manifestly to consist chiefly of bile. 

" From this circumstance, I conclude that the disease de- 
pends upon an increased secretion of bile, and its copious 
effusion into the alimentary canal ; and, as in this it irritates 
and excites the motions above mentioned, I infer, that the bile 
thus effused in larger quantity is at the same time also of a 
more acrid quality. This appears likewise from the violent and 
very painful gripings that attend the disease, and which we can 
impute only to the violent spasmodic contractions of the in- 
testines that take place here. The spasms are commonly 
communicated to the abdominal muscles, and very frequently 
to those of the extremities. 

" In the manner now described, the disease frequently pro- 
ceeds with great violence, till the strength of the patient is 
greatly, and often suddenly, weakened ; while a coldness of 
the extremities, cold sweats, and faintings come on, an end 
is put to the patient's life, sometimes in the course of one 
day." 

Now, I contend that the cholera above described is the 
same with that which has lately appeared in Great Britain, 
and now said to be imported through emigrants from that 
country into Canada, and from thence threatening our own 
cities, with this, and this only difference, that the latter is of 
a more malignant character* That the remedial treatment 



13 

ought to be radically the same, differing only with the inten- 
sity of the symptoms, and increasing in power in proportion 
to the violence of the disease. 

Here then we have a disease whose symptoms not only, but 
whose effects prove to a moral certainty the existence of a 
highly deleterious and morbid secretion in the first passages 
of the alimentary canal — that this morbid matter is of an acrid 
and vicious nature, producing a painful, griping, and spasmo- 
dic action in the intestines, and, in proportion to its intensity, 
calls into sympathetic action the muscles of the abdomen and 
of the extremities. This secretion is sometimes so acrid and 
of so poisonous a nature, that its effects on the system bear a 
strong analogy to the effects of arsenic. Physicians have 
often mistaken the symptoms of poison by arsenic for cholera 
morbus ; and I distinctly recollect that in the first case of poi- 
son by arsenic to which I was called, unsuspicious of the 
cause, I thought it a case of cholera, and I sat by the bed- 
side of the patient several minutes before the suspicion of poi- 
son entered my mind. 

It was this strong analogy in the respective symptoms of 
cholera and mineral poison that undoubtedly excited the sus- 
picions of the people of Paris that their waters and liquors 
had been poisoned with arsenic. 

The interest of the subject will, I hope, be an excuse for this 
long preface to my concluding position. Now then, for the 
Remedy : 

First. Remove as speedily as possible, the offensive matter 
from the stomach and intestines in the manner that nature 
indicates by her perhaps too feeble efforts, vomiting and 

PURGING. 

Secondly. Allay the spasmodic affection by anodynes. 

It is evident, that while the morbid or poisonous matter re- 
mains in the bowels, causing the most intolerable, tormenting, 
and excruciating pains, eating and corroding as it were the 
parts in contact, I say, it is evident, that under such circum- 
stances the patient must die, unless this matter is ejected, 
either by the spontaneous efforts of nature, or by active 
artificial means. 



14 

How then shall we proceed? Pursue nature and common 
sense, and administer vomits and purgatives ? Or, shall we 
adopt the more scientific course recommended by the 
" Edinburgh Board of Health !" Gracious heaven! " opium 
and camphor ! !" and that in cholera morbus, while the poor 
patient is writhing in agony from the noxious poison that is 
constantly gnawing his vitals — " opium and camphor!" For 
what ! to lock up, to retain by force, and against the efforts 
of nature, the villainous poison in the system ? 

I would ask what physician could be so mad, so scientifically 
mad, as to use the most active remedies to retain the offend- 
ing secretions where nature and common sense indicate the 
propriety of encouraging their most speedy evacuation ? Yet 
such is the tendency and such the effect of opium and cam- 
phor, and carminative drafts. The fatality said to have oc- 
curred at Quebec, where almost every case proved fatal, 
would induce one to believe that the Edinburgh recommenda- 
tions had been adopted to the very letter. 

For my part, I do not believe that this disease would be 
half so fatal if left to its own natural efforts, as it is under such 
unnatural and ill judged treatment. And I do further think, 
that a proper mode of treatment, under the views taken of it 
by all respectable writers for ages past, with the addition of a 
more bold practice on the established principles of its cure, 
would disarm it of its terrors, and subject it to the power of 
remedies. This disease has for the last fifteen years raged in 
Asia as an epidemic. Its mortality in the country of plagues 
is not to be wondered at : but in a European or American 
climate, it ought to be, and I believe can be, rendered compa- 
ratively mild and innoxious. 

In the spotted fever, or cold plague, as it is called, which 
prevailed in Vermont, New Hampshire, &c. in 1811, and the 
subsequent amelioration of the same fatal disease as it appeared 
in this state during the winter of 1812-13, in the character of 
an epidemic bilious malignant fever, manifesting many of the 
symptoms attributed to the prevailing cholera — I recollect a 
similar panic prevailed among the physicians, as now — and, 



15 

because a bilious disease appeared in a new form, it there- 
fore was thought to require a new, or unheard of treatment. 
At that period, too, we had the advisers and the advocates of 
opium, camphor, wine, brandy, and all the family of stimu- 
lants. Bleeding was recommended by some — sweating by 
others. Under this mode of treatment the disorder proved 
fatal in from four to six cases out of ten, where medical aid 
could be procured ; but in those parts of the country, parti- 
cularly in the western part of this state, where the population 
was too scattered to enable the sick to obtain medical aid, the 
mortality was not half so great. I had this latter fact from an 
intelligent farmer, a member of the legislature from Ontario 
or Niagara county. But where a more rational mode of 
treatment was adopted — where, instead of opium, camphor, 
and other stimulants, to stop nausea, vomiting, violent pains 
in the head, chest, and extremities, torpid action of the vessels 
of the skin, coldness of the extremities, he, the attention of 
the physician was directed to emptying the first passages, by 
vomiting and cathartics, that dreadful epidemic lost its terrors 
and became as manageable as a common fever. 

How far, or whether any impression favorable to the stimu- 
lating or quieting plan of the " Edinburg Board of Health," 
has been made upon our physicians I cannot say. Judging 
from the character of those with whom I am acquainted, I 
doubt, nay disbelieve any concurrence in any such doctrines. 
Many of our physicians have had some experience in epide- 
mics, and they will bear testimony in favor of my views. They 
cannot think that because measles and scarlet fever have been 
for the last year more mortally epidemic, that therefore they 
should pursue an opposite course of treatment from that 
adopted by them in former or more mild stages of those 
diseases. 

I then recommend, as the best and most effectual remedy for 
malignant cholera, when, or in whatever shape it appear, that 
immediate resort be had to such medium as will cleanse the 
stomach and bowels, and after such evacuation, to allay the 
pains and spasms by small and oft repeated doses of lauda- 



16 

num, say ten drops every ten minutes till the patient is com- 
posed. Camphor and peppermint are both obnoxious to a 
diseased or irritable stomach, and have fashion only for their 
support in any complaints. Cholera morbus generally ter- 
minates in a few hours. After a free evacuation of the con- 
tents of the stomach and intestines in the first hours of attack, 
all danger is past. 

These are my views and opinions of the Canadian cholera, 
or whatever title you choose to give it. The remedy is simple, 
and consists in removing the immediate cause, and calming the 
distressing consequences by suitable anodynes. I hope my 
fellow-citizens may never have an opportunity to test the truth 
or fallacy of my doctrines, which, as far as opinion goes, are 
but the same as those of many of my predecessors ; but if 
they should necessarily become a matter of consideration, I 
shall feel a consciousness that I have done my duty in laying 
before the public an opinion formed on the result of many 
years experience in my profession. I shall at least have the 
consolation to know that I have made this communication 

from motives of 

HUMANITY. 



LETTER TO DR. B. P. STAATS, 

Health Officer of the City of Albany. 

July 12, 1832. 
Sir — I did conceive that the epidemic cholera now prevailing 
in the Canadas, whether of Asiatic, European, or American 
origin, came under the head of that species of disease termed 
by nosologists cholera morbus. I also believed that this 
disease was subject to similar varieties, grades and intensities, 
from a difference in the prevailing exciting causes and consti- 
tutional susceptibilities, as in typhus, bilious remittent, bilious 
malignant and yellow fevers, and I intended to offer a few re- 



17 

marks, as suggested to my mind from some experience and 
observation on the nature, tendency and cure of those diseases. 

Anticipating the time when both our city and yours would 
be visited by this threatening pestilence, I had commenced, 
on the first of the month (July) some observations on the 
subject; but the performance of my intention was suspended 
by the sudden appearance of the disease in this city, in order 
that I might learn by experience what I otherwise could have 
treated of solely upon the authority of others. 

On the 4th of July I availed myself of an opportunity to 
see three cases of reputed " Asiatic Cholera." They proved 
fatal. I examined each case minutely — received satisfactory 
replies to all my inquiries, although one was at the time in 
articulo mortis. 

From this period, and whilst this communication is pro- 
gressing, I shall visit the " cholera hospitals " from time to 
time, and state such facts and opinions as shall be dictated by 
my observations. 

It is almost impossible to write on any practical subject in 
our profession, without occasionally diverging into theoretical 
deductions ; but as all deductions are mere matter^ of opinion, 
I shall claim no credence beyond probability. 

The disease now prevailing here is not the Asiatic cholera. 
It is no cholera at all, and the term is a misnomer. We have 
before us the history of the Asiatic disease, and partially of 
the Canadian type of it. I have examined the reported cases, 
in our cholera hospitals. I have especially noticed those whose 
symptoms indicated dissolution, and who have since died. 
I have made my observations on both questionable and de- 
cided cases, and have not seen a single one that was marked 
by any symptoms of cholera morbus. No similitude to 
Asiatic cholera other than in the simple fact of extinction of 
life, I make this assertion in the face of hundreds who are 
daily visiting the hospital, and consequently hazard contra- 
diction and disgrace if I falsify facts. I shall now state pre- 
cisely what fell under my own notice. 

I found, in the examination of the cases, that there was not 



18 

only a general, but an almost particular similarity of symp- 
toms. A somewhat restless and a bloodless countenance — 
an evident recession of the blood from the surface and extre- 
mities, occasioned by a feeble and asthenic action of the 
heart, or of exhaustion from excessive stimuli — consequently, 
cold skin and extremities. This abstraction, as it were of 
blood, and consequently of heat, from the surface of the 
body, gives a sombre hue to the countenance, and a shrivel- 
ling of skin, which are perceptible in all the dangerous cases. 
There was no agony, no severe pain, no vomiting, no 
diarrhoea, not a groan nor a complaint during the time I was 
passing from room to room, and from patient to patient. To 
my question, have you any pain ? the universal reply was, no, 
or but a slight uneasiness in the bowels. To the question, 
were you seized with violent pains and cramps? No. — In 
some few cases the attack had commenced with looseness, or 
a little pain in the bowels. There is not that remarkable 
dark or blue appearance so much talked of, and I could per- 
ceive no other appearances than I should have expected from 
asphyxia or drowning. Death seems to have no terror ; and 
life is extinguished as a lamp whose oil is exhausted. 

That some cases have occurred of violent cramps and 
spasms, I am fully aware. I only say that these symptoms are 
not common to the disease in question. I can say so con- 
fidently, while in passing about half an hour in the midst 
of fifteen or twenty cases, I neither saw a spasm, a contortion, 
an emission either by vomit or stool, nor heard a scream nor 
a groan. 

I am sure that, in what I have stated, you will not re- 
cognise the disease with which common fame has credited us. 
Our malady however is a mortal one as far as it goes. Death 
occurs in a very short period, and I cannot learn that a 
single decidedly marked case has as yet recovered. There 
are in this, as there always will be under similar circumstances, 
an abundance of imaginary or medical cases, which at any 
other season would hardly call for medical aid. I have 
this moment returned from a visit to the hospital — out of 



19 

about twenty cases, there are not more than three with the 
marked appearance of the reported disease. 

Having now stated that the disease is not the Asiatic 
cholera, nor cholera of any description; you will naturally 
ask me what it is? A question much easier asked than 
answered. 

A cholera presumes bilious matter secreting either super- 
abundantly or acridly, so as to produce violent pains and 
spasms in the intestines, the abdominal muscles, and the 
muscles of the legs and arms, and almost incessant vomiting 
and purging. Cholera morbus is a genus of disease arranged 
by Cullen in the class neurosis and order spasmi, and is 
defined " a purging and vomiting of bile with anxiety, 
painful gripings, spasms of the abdominal muscles, and those 
of the thighs. There are two species of this genus: 

" 1. Cholera spontanea, which happens in hot seasons with- 
out any manifest cause. 

" 2. Cholera accidentalis, which occurs after the use of food 
that digests slowly, and irritates." This spasmodic affection is 
altogether symptomatic, and has the same and no other 
relation to the exciting or irritating matter in the duodenum, 
than a cough has to any irritating matter that may be inhaled 
into the lungs. Cramps are the mere result of exciting 
causes in the stomach or intestines. In some they never 
occur ; in others the slightest irritation brings them on. 
Every nurse is familiar with this symptom, where crudities or 
indigestive substances become offensive to the stomachs of 
children ; and physicians know that some persons are always 
cramped from vomiting. 

I find that this symptom — this cramp — which in truth 
comes as a relief to the stomach in like manner as the incubus 
does to apoplexy, is made the great bugbear and terror of 
this disease. 

Spasms are never dangerous, and they always come in aid 
of nature against some deleterious attack upon the nervous 
system. Witness their severity and continuance on the weak 



20 

female frame for days, and sometimes weeks, without any 
ill effects. 

But, you again ask, what is it? I can only say, that, 
judging from the cases I have seen, the disease prevail- 
ing here under the name of Asiatic cholera, is not that dis- 
ease. That it is no cholera morbus, but a species of pest 
or plague, indigenous to every place where its ravages have 
been known. It is to the universe what typhus, bilious 
and yellow fevers, hooping cough, measles, influenza, chicken 
pox, dysentery, ophthalmia, &c. are to certain districts 
of country. This disease is not, as I expected to find it, 
of a bilious character. The evacuations from the stomach 
and bowels contradict the suspicion ; they are watery and 
less feculent. The majority of the patients in the cholera 
hospital have informed me that their evacuations were bilious, 
both from stomach and bowels, when they were first attacked : 
these cases were not dangerous. They were common cholera, 
and so light that they hardly deserved the name. How 
far laudanum, camphor and brandy will change this character 
into malignant cases, I leave for you to imagine. There 
is probably a deficiency of bile, and in its place we can 
only imagine some unnatural, poisonous, and morbid secre- 
tion distilling from the gall-bladder into the duodenum, of a 
nature little, if any, different in its effects from prussic acid 
or arsenic. Judging from its operation, it is, according 
to its intensity, as fatal. 

The symptoms in some of the most violent cases, as re- 
presented to have occurred in Canada, do certainly bear 
a strong analogy to the effects of poison from arsenic, even to 
the extent of post-mortem examination. The same suffering 
and agonizing contortions of body and anxiety of counte- 
nance, the same appearances in articulo mortis, and the same 
rapid decomposition on the extinction of life. 

So remarkable were these facts at the commencement of the 
disease in Paris, (I now speak of it as it appeared on the 
continent of Europe) that a panic prevailed amongst a portion 



21 

of the inhabitants of that city, suspecting that their water, 
and other liquors, were impregnated with arsenic or other 
mineral poison. 

I shall now state what I consider to be the exciting cause 
of this singular malady ; a malady in which the powers of life 
seem to be blasted like a leaf from autumnal frost. There is 
no previous fever, no efforts in the vascular system to rid 
itself of morbid excitement, but they wither under this pesti- 
lential sirocco without the power of resistance. If nature could 
infuse a sufficient power of action into the arterial system, 
were it but sufficient to aid in the expulsion of the offensive 
poison, art might more successfully lend her helping hand; 
but in this case there is complete and almost irremediable 
prostration. The action of the heart grows weaker every 
hour, congestion takes place as the blood recedes to the 
heart, and the patient dies as from asphyxia. 

What is to be done ? To answer this, we must theorize till 
experience decides. We must assume one of two propositions : 
first, that the disease, as far as we can trace a cause, is owing 
to the concentration of a morbid, virulent, and highly noxious 
secretion from the hepatic organs into the intestines, which 
there produces the deleterious effects observable ; or, second, 
that there is a general morbid poison pervading the whole 
vascular system, and sinking into inertness by a direct ab- 
straction of the powers of life. I have adopted the first of 
these propositions, as being in my judgment the more rational 
and accordant with what I have previously seen in diseases 
bearing the strongest resemblance to the one in question. 
On this opinion is, of course, founded my principle of cure. 
This may be summed up in a few words : where deleterious 
or offensive matter enters into the stomach or bowels, nature 
sickens at the intrusion, and exerts her efforts to throw it off. 
If the matter have not gone beyond the stomach and bowels, 
she rouses these into action to regurgitate, or carry it off. If 
it has gone beyond these, and entered the secretory vessels, 
she defends herself by a fever to throw it on the surface by 



22 

perspiration. This course nature pursues to cure herself. If, 
however, a poison should enter the system beyond the power 
of nature to reject, art must come to her relief, or lingering 
disease or death must follow. 

In the disease under consideration, whatever may be the 
secretion, so complete and so rapid a typhoid state of the sys- 
tem follows, as to render the stomach and bowels too feeble to 
rid themselves of the morbid matter. Their efforts are partial 
and inefficient, vainly struggling to overcome the noxious mat- 
ter, as they would an over-dose of opium or arsenic, and the 
corroding evil is suffered to prevail in death. It is to this en- 
feebled power, this sinking state, that I would wish to give 
energy and the tone of reaction, by assisting nature. I would 
endeavour to rouse the stomach into action, to stimulate the 
ceasing powers of the heart, to throw into rapid circulation 
the languishing blood, and, if possible, simultaneously to eject 
the morbid matter from the first passages, and, by an artificial 
fever, recover the lost action of the surface of the body. And 
how is this to be done ? Through the medium of the stomach, 
and in no other way can I conceive it possible. Your fric- 
tions, steamings, and bathings, are mere mites in so formidable 
a condition of the system ; your enemas are of no avail ; your 
blisters, leeches, and embrocations are worth nothing to a 
patient sinking under typhoid oppression. Your diffusible 
stimulants, laudanum, brandy, he, only confirm the disease, 
lock up the passages, prevent if possible all evacuations, upon 
which the cure depends, give the common cholera a type 
of malignancy, and close the "blue" or "black" scene in 
death. It must be done by a power superior to the disease, 
or it will fail to conquer. The exciting cause, if stronger than 
life, must be removed, or the patient must die. And it must 
and can only be removed by active emetic and cathartic medi- 
cines. It has been objected to this course that emetics are 
inadmissible, ill timed, and dangerous, in a disease where the 
stomach is already too irritable, too feeble, or too exhausted 
to admit of their use. Indeed ! Let us examine into the 



23 

medical philosophy of such an objection. Suppose that a 
person takes six grains of corrosive sublimate — an incessant 
vomiting and drastic purging ensue — the person soon becomes 
exhausted-^— -the powers of the stomach lessen, and cramps seize 
the limbs. Would a rational practitioner in this case argue 
against the administration of an emetic on account of " too 
great irritability, exhaustion, weakness, he, ?" The idea is 
preposterous. No ; he would use every means in his power to 
excite a new action in the stomach, and disburthen it of its 
morbid contents. 

Again, suppose a person to swallow half an ounce of opium ; 
the effect of this goes almost immediately to the heart — the 
stomach gradually becomes torpid — the efforts to vomit are 
feeble — prostration ensues — and the appearance of death marks 
the countenance. Here also, upon the objectionable principle 
to emetics, their effect would aggravate the disease. But what 
is the fact t And where is the physician who would hesitate 
a moment on their exhibition ? What, I will ask, would be 
the effect, in either of the above cases, of laudanum, brandy, 
peppermint, and camphor? Let common sense answer the 
question. 

My remedy then is, to vomit or purge off the offending 
matter, be it what it may; and if pains or spasms continue to 
exercise the system after a free evacuation, especially by the 
bowels, give ten drops of laudanum every ten minutes until 
they cease ; or at once give a full dose, of ether a tea spoon- 
ful, and laudanum fifty drops, mixed together in some liquid 
agreeable to the taste. 

If the vomiting in this disease should be too incessant, and 
reject a full dose of an emetic, of which I prefer the tartrite of 
antimony (tartar emetic) before all others, I would, as I have 
been obliged in cases of yellow fever, dissolve twenty-four 
grains in eight ounces of water, and give a table spoonful 
instantly after each ejection from the stomach ; in such case, 
after eight or ten spoonsful have been taken, a small portion 
will have touched the coat of the stomach, when longer inter- 
missions will soon follow, and eventually a complete emetic 



24 

effect be produced. When once the first passages have been 
cleared, all danger from the disease is over ; mucilaginous 
drinks, and occasional gentle laxatives finish the cure. This 
treatment is applicable to malignant cholera, and I shall rely 
on it for the treatment of the prevailing disease, which wants 
but one symptom to constitute it the Asiatic disease, and that 
is cholera* All the cases that I have seen in the hospital, 
which I have considered as ordinary disease, have in their 
commencement ejected bile. These will recover if they are 
not frightened into a worse stage, from their situation, or me- 
dicated into the disease. I would by no means have it under- 
stood that I would administer emetics in the forming state or 
first stages of the disease, unless accompanied with symptoms 
of nausea or vomiting. For premonitory symptoms I would 
and have now successfully used, a powder consisting of two 
parts of tartrite of potash (soluble tartar) and one of jalap — 
dose twenty grains every two hours till it operates freely ; or, 
if more convenient, castor oil. 

I shall now consider the other proposition, and suppose the 
disease to be a general and not a specific agent of the un- 
known cause ; that the secretions in general have become 
contaminated, and that the heart and vascular system are 
withering under their morbid influence. 

Upon this hypothesis, I will agree, that the general course 
of prescription and practice recommended and pursued by the 
majority of our physicians, in the administration of laudanum, 
brandy, camphor, and other diffusible stimulants, may be 
correct. But I would prescribe them on a very different 
principle from that avowed by its advocates, viz. to subdue the 
pains, spasms and nausea at the stomach. This state of the 
system presents for consideration a question, not between 
pain and ease, but between life and death ! The heart must 
be stimulated by the exciting power of these diffusible and 
powerful agents, through its only medium (except the lungs) 
the stomach. 

In such case, where high stimulants are admissible in order 
to bring on reaction of the heart and blood-vessels, I think 



25 

that physician cannot have profited much by experience who 
would hesitate to add antimony to their powers. 

What medicine have we that is more actively diaphoretic, 
or perspirative I Is it not noted for its powerful tendency 
to the skin in the most obstinate and debilitating fevers, and is 
not that a prevailing object to be obtained in this disease ? 
As well might you object to the abstraction of blood in all 
cases of oppressed circulation. And if too much blood can 
produce a dangerous state of debility, which requires its ab- 
straction, so can too much vomiting-matter, producing similar 
effects, claim a similar remedy for its relief. 

I wish to guard you against the impositions daily practised 
on this community by false reports. Our health police is 
most injudiciously formed, and withal embarrassed by con- 
flicting opinions between its members and the physicians, and 
between one portion and another of the physicians themselves. 
There are almost as many opinions and doctrines as there are 
doctors; and they and the board of health become more 
choleric than the poor sufferers under their respective cares. 
Our board of health is so constituted, that it cannot or does 
not refuse the acceptance of the report of any licensed physi- 
cian. Of this description there are a hundred courageous 
enough " to seek reputation in the cannon's mouth ;" and 
there is not a filthy hole unsearched to find some drunken or 
starving wretch who may have some symptom that will justify 
a report, or send him to one of the hospitals. Should the 
latter be done, then indeed is his case deplorable. Appalled 
by fright, disease and death on one hand, and the doctors on 
the other, science cannot save him, and he dies a martyr to 
the cause of cholera, cajeput, and camphor. The reports in 
our city are false; and from the best information that I can 
gather, and from my own observation, I believe that the cases 
of what is termed Asiatic cholera, which have appeared in this 
city from the 1st to the 12th of July, do not average more 
than six a day. The number of cases reported yesterday 
(11th July) is 129! Rely upon it, not more than 9 of them 
are what may be called Asiatic or malignant cholera. If 

4 



26 

I have one desire chief in my mind, it is that I might 
have the pleasure of your company, and pay a visit to our 
"several hospital departments, there to witness what is here 
styled " Asiatic cholera," and you would then more fully ap- 
preciate the truth of my statements. 

I believe that as yet not a single physician, nurse, nor 
attendant in our public institutions has been attacked ; nor 
can I learn that an indisputable case has occurred in any indi- 
viduals, except among the poorer class of foreigners, and the 
poor, filthy, and drunken of our own country. 

I now close with my best wishes that you may be spared 
this calamity, or be more successful in curing terror and 
disease than we have been, in this our devoted and libelled 
city of New-York. 



TO BENJAMIN ROMAINE, ESQ. 

Sir, New.Yorh, July 20th, 1832. 

In our conversation yesterday, on the character and 
treatment of the prevailing epidemic, you expressed your 
surprise at the unnatural and inconsistent manner in which 
physicians treated it. The fact of our agreeing in opinion 
was the more gratifying to me, as I have reason to esteem 
your ideas on such a subject more consonant with unbiassed 
judgment than those of a majority of the medical profession 
of the present day. I know that you have witnessed, and been 
familiar with, every epidemic that has prevailed in our city 
for the last fifty years ; and, although not a physician yourself, 
I know that you have watched and scrutinized the symptoms 
and treatment of those several diseases with the eye and the 
judgment of a philosophical inquirer. I know that you have, 
during the most calamitous times, associated and been intimate 
with the most learned and eminent physicians of by-gone 



27 

days, that you have learned and appreciated their opinions 
and practice; and that you have been a strict observer and 
commentator upon a subject where common sense has ever 
taken the lead of wild theory and authoritative practice. To 
have my own opinions therefore approbated by a mind imbued 
with such qualifications for judgment, is as gratifying as it is 
complimentary. 

A physician who has studied his profession in books, and 
tested authorities, by years of practice at the bed-side of his 
patients, ought to be qualified to form his judgment of the 
character and nature of every and any disease that might 
come under his observation, or whose symptoms should be 
truly described. The relationship of remedies in a new dis- 
ease he can only judge of by analogy, or by personal adminis- 
tration. For any information beside these two points he must 
resort to his own learning and his own experience — beyond 
these no authority can avail him. The falsity of authorities 
stares him in the face from as many sources as there are 
authors : and instead of exercising his own judgment, founded 
on his own experience, he becomes lost in the wilderness of 
conflicting dogmas and theories, which render his course of 
practice a game of hazard. 

After reading an hundred authors on the theory and prac- 
tice of physic, whose opinions and treatment are at variance 
with each other, and whose inconsistencies cannot be reconciled 
by the common measure of reasoning — who, although start- 
ing from the same point, and having the same object in view, 
yet diverge into several and separate directions, I ask, what 
reliance can be placed on such authorities ? 

Do I profess to be a physician, I should certainly be com- 
petent to know my remedy when I see and examine the dis- 
ease I am to treat. The physician ought to be like the natu- 
ralist, who meets an animal, or plant, or a mineral, which is 
new to him, or has never been described by authors — he finds 
the family it belongs to, and whatever its variety, he traces it 
back to its order. So will an experienced physician, when he 



28 

meets with a disease whose symptoms are novel to him, be able, 
from some associate symptoms, to observe it's, family and trace 
it to its order. If now his own judgment, the result of former 
experience, the knowledge of the powers and susceptibilities of 
the human system, the properties and operation of medicine, do 
not give him sufficient confidence to rely upon his own re- 
sources, without continually seeking after and applying to 
authorities in order to guide his judgment, he is not fit to be 
trusted in any disease, much less in one of a dangerous cha- 
racter. 

Our epidemic cannot most assuredly be so singular, so un- 
common, so foreign to all analogy, since our physicians are 
literally quarreling as to whether certain cases are the new or 
the old-fashioned cholera of our country. There must, at 
least, be a family likeness. The malady that afflicts us at 
this time is evidently of domestic origin. It is folly, and an 
idle waste of time, to trace it to Asia. It is not contagious — 
a fact also indisputable. It is mortal — a fact amply proved. 
To say that " the disease is not dangerous, and can be easily 
cured," is mockery. Its fatality has been proved- — its danger 
has been proved, or the conduct of our citizens and authori- 
ties is a mere farce. 

Those who sink under it have, from their mode of living, 
rendered their systems susceptible to this peculiar species of 
disease, and I believe that the general constitution of the in- 
habitants partakes more or less of this predisposition. It is 
idle to ask for a remote cause : but it is not half as likely to 
be in the air as in our food and drink. 

I believe that the number of cases which would naturally 
slide into the asthenic, or deadly stage of the disease, is much 
less than that of those who are daily medicated into it by the 
popular mode of practice, adopted from imitation or authority. 
Many, also, who are daily reported would never, I apprehend, 
become cases even of the second stage, were it not for the un- 
timely abuse of opium, laudanum, camphor, &c— remedies 
slavishly adopted and pursued both in the suspected and inci- 
pient state of the disease. 



29 

Almost every sensation, be it ever so slight, that the imagi- 
nation, or a little rumbling of the intestines, or uneasy diges- 
tion can produce, is immediately construed into a " premoni- 
tory symptom," and is forthwith followed by medicines, which, 
instead of proving, as intended, correctives, are in reality the 
means of locking up and retaining the morbid secretions, if 
any exist, and induce the very state of things they were in- 
tended to prevent. 

There should, in no instance, be given any thing but mild 
cathartic medicines, where there is neither nausea, nor vomit- 
ing, nor a preternatural diminution of heat on the skin. In 
cases where the natural heafrof the skin is^either increased^or 
diminished from its usual standard, accompanied with nausea 
or vomiting, I would have immediate recourse to an emetico- 
cathartic, composed of four grains of tartar emetic and six 
grains of calomel. 

Where spasms occur, I consider them merely symptomatic 
of the irritating effect of the secretion in the first passage of 
the intestines, and instead of soothing, palliating medicines, I 
would, by the first and most active means in my power, remove 
the morbid matter : and in case the symptomatic affections 
cease not with its expulsion, it is then in time to resort to pal- 
liative or anti-spasmodic remedies. 

I believe that the real cases of this mortal malady bear but 
a small proportion to the artificial ones ; and it is not to be 
wondered at, when every indisposition to which a " premoni- 
tory symptom of the Asiatic cholera" can be referred, is, by 
a certain class of our profession, considered a sufficient foun- 
dation for special report, and treatment " in all such cases 
made and provided." Of this I have witnessed a number of 
instances. 

In confirmation of the truth of my last position, I need 
only refer you to a circumstance which occurred in Canada. 
It seems that a stranger of singular appearance came to Mon- 
treal while the epidemic raged at its height, and proffered his 
gratuitous services to the afflicted, in prescribing a new and 
certain remedy for the disease. Common fame has given 



30 

much credit to his success. His name is Stephen Ayres. 
His prescription, as given in the Montreal papers, was 

Two spoonsful of charcoal. 

Two do. of lard. 

Two do. of maple sugar. 
That this prescription has the slightest power on the system 
in so formidable a disease, my credulity cannot digest. Its 
value and prophylactic powers consist in its entire inertness or 
its mild cathartic nature ; yet the fact speaks volumes. Happy 
would it be for our city were certain of its professional mem- 
bers as sensible men as Stephen Ayres ! 

In times of universal sickness, there has always been a kind 
of epidemic fancy amongst the otherwise healthy but timid 
portion of the community, which reads and breeds symptoms. 
At these times the mind, for want of the usual stimulants that 
support it in the active and busy concerns of life, becomes 
enervated by dieting, as it were, on sympathy, as well as be- 
ing the victim of fear and apprehension. Hence every alarm- 
ing report is calculated to increase its fears, and it readily 
yields to the slightest and otherwise unobserved variety of 
sensations to which it is daily subject. It is a well known fact, 
authenticated by medical history, that the human system can, 
through the medium of imagination, be brought into a state 
of that most terrible of all diseases, hydrophobia. And I 
can testify from my own observation within a few days past, 
that I have witnessed several cases of common and every-day 
irritability of the stomach and intestines, ushered into the last 
and mortal stage of the prevailing epidemic by apprehension 
and laudanum. 

But, to return to Dr. Ayres and his plan of treatment. In 
the Montreal Herald of the 7th inst. is the following article : 

" FACTS ARE STUBBORN THINGS. 

"When the Indian chiefs from Caughnawaga visited Mon- 
treal with the view of obtaining, if possible, some stay for the cho- 
lera, which was so rapidly depopulating their village, they re- 
paired to the house of Mr. Joseph Lancaster^ where they were 



31 

kindly entertained whilst search was made for Dr. Ayres, who 
returned with the chiefs, taking with him a supply of his mate- 
ria medica. The deaths up to that time were sixty-two. 
There were then existing sixty-three cases, and in the course 
of the first twenty-four hours thirty-six new cases occurred, 
making in all ninety-nine. A very respectable person who 
left Caughnawaga yesterday morning, and whose word cannot 
be doubted, affirms, that when he departed, ninety-three out 
of the ninety-nine were up and walking about, and he fully 
expected to find the other six convalescent upon his return. 
Such extraordinary success had naturally raised in the breasts 
of the Indians a veneration for their preserver, little short of 
worship. His successful practice, however, there, as in Mon- 
treal, had been the source of jealousy and bad feeling in a 
quarter where it was the least to be expected." 

While copying the above extract, a circumstance occurred 
to my mind, the relation of which will apply strongly to the 
confirmation of the success of Dr. Ayres' treatment, and will, 
in no small degree, open our eyes to the delusion under which 
the public labour with regard to the epidemic. I allude to 
the successful mode of treatment of Monsieur Chabert, the 
noted "fire king" and " professor of antidotes to poisons." 
He appears to be a plain, intelligent, and benevolent man ; 
has seen much of the world ; has gathered a number of recipes, 
and understands well the human character. I have seen this 
man, in the presence of a large assembly, composed of medi- 
cal and other scientific men, take upwards of thirty grains of 
phosphorus, which I administered myself, at a dose, while not 
a man in the room would have dared to take five grains for 
fear of being poisoned ; and probably without any other anti- 
dote than his own good sense and confidence in the nature 
and power of the material. In a conversation with him on 
the subject of this disease when it first made its appearance in 
this city, he asked me whether I did not consider it of a bilious 
nature? I answered him, "most assuredly the disease must 
be bilious if it is a cholera," and that the cure would depend 
" on the most active and prompt remedies that would evacuate 



32 

the contents of the intestines." Mr. C. appeared pleased with 
my suggestion, and told me that in his travels through South 
America he had, among the natives, met with a vegetable 
substance whose action on the stomach and bowels was almost 
instantaneous, and manifested a disposition to test its efficacy 
in the cholera morbus now prevailing. I observed to him 
that if such was really the effect of his remedy, I doubted not 
that he would be more successful than many of our professional 
men, who threatened a mode of treatment of an opposite cha- 
racter — retaining instead of evacuating the bilious secretions. 
I have not again met with M. Chabert except through the me- 
dium of the newspapers, where I find him offering his gra- 
tuitous services to the public. I have since frequently called 
at the hotel where he resides, and there learned that he had 
from fifty to one hundred calls daily from invalids who had or 
thought they had the " premonitory symptoms." I have at 
least as much confidence in the statement in his advertisement 
that " he had treated 528 cases and lost four by deaths," 
as I have in our daily city and hospital reports. Now what 
does this statement of facts argue ? M. Chabert gives active 
cathartics together with his specific anti-cholera drops, and 
our city and hospital physicians, with a few exceptions, ad- 
minister laudanum, brandy, paregoric, camphor, he. Look 
at the success of the two modes of treatment. Does it not 
prove that the mortality among us which spreads terror through 
every section of our country, and creates the most gloomy ap- 
prehensions among those who have j^et to suffer, is owing to 
a course of treatment at ivar with medical philosophy, common 
sense, and rational practice ? 

I cannot for my part be persuaded that a twentieth part of 
M. Chabert's patients have any real " premonitory symptoms," 
any more than I can believe that our city and hospital reports 
comprised that proportion ; but I can very easily compre- 
hend that the gently-physicked portion of them will get well, 
and that that portion which are scientifically drugged and 
opiated will get sick in good earnest, and many of them die 
in their existing state of mind and body. 



33 

I do not hesitate to declare it boldly, that if the laudanum 
and brandy treatment were to be abandoned for one week, we 
should have but few deaths a day of epidemic cholera, except 
among the beastly intemperate. I know that it is degrading 
to our profession to draw this inference, but I believe it to be 
strictly true. 

It has been gratifying to learn that several of our old and 
experienced practitioners treat the disease according to its 
symptoms ; and that the ordinary indispositions of the season 
are met in their ordinary course of treatment : hence, these have 
no "cholera cases" to report, no "cholera deaths" to record, 
beyond their usual number. They do not give opium in every 
little ache and pain that alarm the fearful and nervous. Our 
epidemic might in truth be styled cholera opiata. 

One word more on the subject of medical missions from 
various parts of the country to our city, to " see the disease, 
and learn its mode of treatment." If those who compose 
them, instead of exercising their own judgment, adopt the 
opinions and treatment prevalent among us, and recommended 
in several foreign treatises, it would have been better had they 
staid at home, and met the disease " with a christian resigna- 
tion to the will of divine providence," and, in that event, they 
and their constituents would have been gainers. 



TO DR. HENRY BACON, 

st. mary's, Georgia. 

New. York, Aug. 1, 1832. 
Sir, 

In a former letter I mentioned to you what were my 
opinions of the " Asiatic cholera," its character, remedies, &c. 
and shall now reply to that portion of your letter wherein you 
ask my opinion of quarantines, cordons, and medical police. 

No quarantine regulations in this or any other country 
appear to have had the effect of preventing the spread of this 
disease, allowing it all to have been of the same character. 

5 



34 

Every physician of eminence in Europe and in this country, 
who has watched and studied the progress of the epidemic, has 
pronounced it non-contagious, and many facts assure us that 
it is not infectious. Quarantine regulations have, however, 
been all the fashion in Europe, and we have adopted them in 
this country in the face of contradictory facts to their effi- 
ciency. 

The more sensible and thinking portion of the community 
with us, are ready to allow that its progress is not by con- 
tagion ; but they deem it expedient to yield to the terrors and 
apprehensions of the panic-struck multitude, and acquiesce in 
conceding to their fears and their prejudices, what reason and 
past experience have exploded as useless and unavailing. 

If the leading men and the authorities of towns and cities 
would consult the past events, in connection with the progress 
and unstemmed current of the pestilence, they might easily be 
convinced of the utter absurdity of warding off a non-conta- 
gious epidemic, by any power but the interposition of Pro- 
vidence. 

If this pestilence can one day be seen to spring up on the 
shores of the St. Lawrence, and on another day in the city of 
New- York, leaving untouched the intervening country for 
a distance of more than 400 miles, what signifies your non 
intercourse ? Some future historians will record our folly and 
our credulity in the same chapter of events with Salem 
witchcraft, divining rods, and animal magnetism. 

Boards of health are, and have proved to be, a pernicious 
system of medical police. They create and sustain a fear, a 
curiosity, and a feverish anxiety which is constantly in a high 
state of excitement, and possesses a morbid craving that is 
never satisfied with common fame, but must be satiated with 
intoxicating wonders I I have, day after day, witnessed this 
remarkable excitement manifested at the approaching hour 
of the report of the board of health, both in the year 
1822, during the yellow fever, and at the present period, and 
its subsidence in a few hours into perfect indifference until the 
next day's reaction. Boards of health are calculated to spread 



35 

alarm, to possess the mind with apprehension, which expe- 
rience has proved to be a great exciting cause of disease. 

Boards of health are mere receptacles of reports of cases, 
and reports of cases are a premium on falsehood. A class of 
physicians whom neither merit nor circumstances have brought 
before the public, now avail themselves of a medium to 
notoriety, and calculate their consequence and their talents by 
the number of cholera cases they may have under their care. 
Through this medium they usher themselves into public 
notice, and batten on public credulity. The respectable 
portion of the medical profession, whose pride and inde- 
pendence forbid a resort to false pretensions, as well as a great 
number of our intelligent fellow citizens, can bear witness to 
the truth of my assertion. I have it in my power here to 
introduce a number of facts to sustain me beyond all cavil, 
but these facts are too unquestionable to admit of doubt. 
" Boards of health" are injurious and unnecessary. 

They are unnecessary, because they do not contribute 
to any essential benefit, but on the contrary effect a great 
deal of mischief through the imposition of falsehood and mis- 
information. They are obliged to accept, and consequently 
to report all cases represented to them as cholera, not only of 
imaginary character, but in a hundred instances in this city of 
manufactured cases, where, upon inquiry no sickness had ex- 
isted, or no being had resided. 

As a substitute, and complete accomplishment of all that 
may be desired by information intended to be elicited by 
a board of health, I would advise a daily report of deaths 
only. This would be a sufficient criterion, a sufficient notice 
to every citizen interested in the premises, and the best and 
only rational guide to his judgment, of the progress and 
danger of the disease. 

As to sanitory cordons, they are ridiculous in the extreme 
to any person who has given the subject a moment's serious 
reflection. I shall not waste a sentence on them. 

In anticipation of the disease, I would advise that all the 
poor and indigent families in your district, town, or village, 
should be visited by a committee. In houses or cabins where 



36 

many are huddled together, with the appearance of poverty 
and filth, I would advise an immediate distribution of their 
inhabitants into commodious quarters, whence, if the disease 
should appear among them, it would be unnecessary to re- 
move them. 

It is my firm belief, and founded on no light conceptions, 
that every patient should die or recover in his own bed, and 
without removal* 

To come to this conclusion, it would be only necessary to 
imagine the agonizing association which must necessarily 
occur to the mind of the patient, when the very act as it were 
of removal assures him of his doom ; and also the state of feel- 
ing at being placed amongst the groaning, the dying and the 
dead, all pleading hopelessness to his case. 

It is not these objections alone that count against the 
removal of patients, but the act of removal not only hastens 
death, but prevents many recoveries. I have known some to 
die on their way to the hospital, and others shortly after their 
arrival, who would probably have recovered, if they had been 
permitted to remain in their own beds. And what can pos- 
sibly be offered in objection to this course? Surely there will 
always be sufficient medical aid and charitable attendance to 
patients at their own houses. But in case of a superfluity of 
domestics, or an incursion of transient poor, I would by all 
means have a provisionary station for their accommodation. 

I have now given you a sketch of my views on the subject 
of quarantines, &lc. as respects the prevailing epidemic; the 
filling up I leave to your own good sense. I hope that this, 
and what I have previously written on the subject of 
" cholera," as it is called, will be considered a full reply to all 
the points of inquiry in your letter. 



ADVICE TO THE PLANTERS 

OF THE SOUTHERN STATES. 



If my views of the character and treatment of the prevail- 
ing pestilence be correct, or as much, or more so, than any 
heretofore promulgated, I cannot perhaps do you a greater 
service than tendering you such advice as several weeks expe- 
rience and constant intercourse with the sick of this city, have 
enabled me to furnish. 

Humanity as well as interest pleads for suitable care and pro- 
tection to your slave population. Negroes, in this part of the 
country, have sickened and died in full proportion to the intem- 
perate white population. You have reason to be seriously ap- 
prehensive of great mortality on your plantations, unless you 
take timely measures to guard against the evil. Anticipating 
then the fact of its appearance amongst you, permit me res- 
pectfully to advise you of the course I deem most favourable 
for an alleviation of, if not an exemption from its malign influ- 
ence. 

1st. Multiply the number of your slave huts or houses, in 
order to leave as few as convenient in the same building, with 
sufficient room to accommodate those of each family in case 
of sickness, without the necessity of a removal — I say empha- 
tically, a removal. My reasons for this have been given, and 
are in your hands. 

2d. Inspire your slaves with fortitude against, and con- 
tempt for, a disease, which they ought to be made to believe 
proves mortal only to the dissipated, the lazy, and the filthy. 
By strongly inculcating these impressions, you conquer the 
greatest exciting cause to an attack. 

3d. Let a vigilant observer, who has acuteness enough to 
do his duty without exciting either the suspicion or alarm that 



38 

his office may occasion, be daily sent to watch over the state 
of health of the slaves. The strongest index to indisposition 
will be found in a diarrhoea or purging, slight or profuse, as 
the case may be, attended with more or less pain over the re- 
gion of the bowels. In some cases, where the morbid secre- 
tion in the bowels is more intense, pains and cramps in the 
legs, &c. will ensue. In this stage of the disease, not one in 
a hundred ought to die, except the really intemperate, whose 
constitutions are a home for this plague. 

The above may be considered as the premonitory, or rather 
suspicious symptoms, and it will be safe to treat them accord- 
ingly. The state of the bowels should therefore be daily in- 
quired into and reported. 

Such planters as may not be able to obtain medical aid 
from a physician, I would advise to procure, as a family me- 
dicine, the following powder : Take of tartrite of potash, or 
soluble tartar, ten ounces, powdered jalap, six ounces. These 
must be well mixed, and immediately put into a wide-mouthed 
bottle or jar, and kept stopped from the air. On the first ap- 
jDearance of suspicious symptoms, a teaspoonful of the powder 
may be administered every two hours, till it has produced 
an evident cathartic effect. Two or three doses will, in ge- 
neral, suffice. This almost invariably relieves the pain and 
purging, and seldom will a repetition of this, or the adminis- 
tration of any other remedy, be required. At all events, 
opium, in any shape, is not essential to a cure, and ought to 
be used in general only by a medical man as a mere pallia- 
tive. But I would advise that each planter have a quantity 
of " liquid laudanum" in his house, to administer in particu- 
lar cases, I mean, when, after a free evacuation from the 
powder, an acute or torpid pain or sensation should conti- 
nue in the bowels or at the pit of the stomach. In such case 
give ten drops of laudanum every quarter of an hour, till the 
pain is alleviated. Upon a recurrence of unfavourable symp- 
toms, I would advise a recurrence to the use of the powders. 
A pound of the powder mixture contains about sixty doses. 
Plaisters of mustard, warm baths, frictions, &c. &c. have 



39 

been recommended. I have no faith in them, nor in any thing 
that does not go at once to the fountain head of the malady, 
and remove its exciting cause. I do not believe this can be 
reached by any external means. 

I shall now close this letter with an admonition to those 
who have no medical aid at hand, that in cases where the 
disease has assumed its worst or sinking stage, where the ex- 
tremities become cold, shriveled, and bloodless, with or with- 
out nausea, vomiting, and purging, they would, as a last re- 
sort, and a confident hope of success, administer an emetic. 
For this purpose I prefer the tartrite of antimony, or tartar 
emetic in a full dose of four grains, or, one grain every ten 
minutes, till it operates, in a solution of cold water. 

As there is sometimes in this disease an incessant thirst, I 
have invariably and successfully indulged my patients freely 
and fully in the use of cold water, in small, but repeated 
quantities. 

If this letter shall eventually contribute to the benefit of 
those concerned, in saving either life or property, the writer 
will have his reward. 



New. York y August, 1832. 



40 



CONCLUSION. 

My first and greatest object in publishing my ideas respect- 
ing the " Cholera Spasmodica," is to impress on my medical 
brethren abroad, who are yet to become acquainted with this 
spreading pestilence, that the cases of real asthenic or typhoid 
" cholera' ■ are very few, and those few principally confined to 
the filthy and intemperate. That the cases of a more respec- 
table character of persons attacked, are rather the result of 
alarm, and common cholera, treated in a most injudicious 
manner. For instance — in case of a slight or common affec- 
tion of the stomach or bowels — a common diarrhoea — if you 
administer, as is now usually done, a dose of laudanum, and 
other ingredients of an astringent nature, you create an arti- 
ficial disease, which unhappily calls for an increased reappli- 
cation of remedies, and a resulting increase of the disease. 
The consequences are obvious. To guard the profession 
therefore against a too hasty decision in their treatment of 
" premonitory symptoms," I shall, to exemplify the truth of 
my premises, adduce some more facts which have come to my 
knowledge through the Montreal papers, respecting the suc- 
cess of Dr. Ayres' treatment. Is there an intelligent and un- 
biassed physician that can misconstrue the cause of Ayres* 
success ? If not, to such, I need only remark* 

** Si hoc noscis, sit tibi satis scire. 19 



[Prom a Montreal Paper.] 

The Caughnawaga Indians. — JosephLancaster, in his "ap- 
pendix to the Gazette of Education," printed at Montreal, 
on the 11th July, states, that a deputation of two of the 
Caughnawaga chiefs came to his house on the 26th of June, 
in search of Dr. Stephen Ayres, who reported that there had 



41 

been 126 cases of cholera at their village and 60 deaths. 
When the doctor saw them, and was made acquainted with 
their wishes, he said, I know I could do you good, but Mon- 
treal is so full of sick and dying, that I cannot leave it. He 
however sent a deputy, a man who had visited a number of 
cases with himself, and knew how to prepare the salutary re- 
medies, promising to go over in a few days himself. An extra 
caleshe was hired to accommodate the chiefs, and loaded with 
charcoal, and every material for compounding the medicine, 
with bottles, and a quantity of the remedy ready mixed. One 
or two of the first cases attended were almost at the last gasp 
before they could be visited, and expired before the remedies 
could be applied. After this beginning, success attended 
every effort, which is corroborated by the report of the resi- 
dent missionary. On the 2d July, Dr. Ayres went down to 
the village of Caughnawaga, and observing that his deputy was 
doing his duty faithfully, and having visited a number of cases, 
and completed the confidence so happily begun, returned to 
Montreal; and on the 10th the deputy returned, with the gra- 
tifying news, that only two cases remained, and that all the 
sick were doing well, walking about, or at work. The 
whole number of cases, as above, from the 18th June to the 
26, was 126, and 60 deaths; and from 26th June to the 9th 
July, 99 cases, and but 8 deaths. On the 11th July, Colonel 
M'Kay reported, that he had visited the village of Caughna- 
waga, by special direction of Lord Aylmar; and had seen 
and inquired into the facts in relation to the cholera, and was 
perfectly satisfied of the truth of the cures performed by the 
simple and salutary remedies of Dr. Ayres. The chiefs were 
then required to make a special report, which they did on the 
same day, at the Indian office, and reported fully, finally, and 
favorably" 

In his appendix of July 16, Mr. Lancaster says, Caughna- 
waga is reported to remain in good health, and adds, accounts 
from St. Johns, represent the charcoal mixtures, even in its 
impure state, as most useful ; and that " its excellency has been 
acknowledged at Lachine and the Cedars." 

6 



42 



[From the Montreal Record.] 

" We have received a verified account of the state of the 
Indian village of Caughnawaga before and after Dr. Ayres 
extended his cholera practice to its population. It appears 
from this document, that the doctor's assistant was despatched 
to the village on the 26th, and returned the next day with the 
missionary's report of the existence of 126 cases and 60 deaths 
having occurred in eight days ! The practice of the doctor 
had now commenced, and his assistant returned to the village. 
On the 2d of July, the seventh day from the practice being 
begun, the missionary reported a total of 130 cases, and only 
four additional deaths ! The doctor now visited the village 
in person, in company of two of the Indian chiefs, to see the 
patients, and to assure himself that his deputy was pursuing 
his directions. On the 10th, the assistant returned to Mon- 
treal, there being no longer a single cholera patient in the 
village to require his services. On the same day a report 
from the missionary at Caughnawaga was exhibited at the 
commissariat office in Montreal, which gave a total of 68 
deaths ; so that from the l8th to the 20th of June, there had 
been 60 deaths in eight days ! and from that time to the 10th 
of July, during which the doctor's practice was in operation, 
there were only eight deaths in fourteen days ! On the 10th, 
Col. M'Kay visited the village, in obedience to special com- 
mands, received from his Excellency Lord Aylmar, and having 
inquired into the facts, reported himself perfectly satisfied with 
the salutary results of Dr. Ayres' practice. 

" The combined testimony of Col. M'Kay and the mission- 
ary, corroborated as it is by the special report made on the 
11th inst. by the Indian chiefs, and by the many Indians who 
are living evidences of the efficacy of Dr. Ayres' practice thus 
fairly tested, is sufficient, one would think, to silence detrac- 
tion ; yet an article is making the round of the public jour- 
nals, the tendency of which is to derogate from its merit, and 
throw discredit on its sanitary virtue. It is not true that Dr. 



43 

Ayres' practice has failed at Chateauguay, as is asserted in the 
article we allude to. Indeed he has not practised there at all. 
One of his remedies, as it was given in the papers some time 
ago, has been resorted to for a cure by many persons afflicted 
with cholera in different parts of the country, as well as at 
Chateauguay, and we have heard, with complete success, ex- 
cept at the latter place, where one case is said to have ended 
fatally. But who would be so partial and unjust as to attempt 
to throw discredit on any medical practice because, in the ab- 
sence of the physician, and without any consultation or com- 
munication with him, a man afflicted with cholera is said to 
have unsuccessfully availed himself of a reported remedy ? 
The article, however, evidently tends to detract from the me- 
ritorious and valuable services rendered to the public by a cha- 
ritable stranger ; fair play is a jewel, and the doctor's poverty 
does not license or justify detraction from the fame his prac- 
tice had deservedly acquired. His practice has been confined 
to Montreal and Caughnawaga, and its pre-eminent success, 
which, as we have seen, is well attested, affords the best evi- 
dence of its value." 



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